Prenatal diagnosis of persistent cloaca accompanied by uterus didelphys: A case report /Uterus didelphys'ye eslik eden persistan kloakanin prenatal tanisi: Bir olgu sunumu

• Published in: Turkish journal of obstetrics and gynecology Vol. 18; no. 1; p. 76
• Main Authors: Sacinti, Koray Gorkem, Oruc, Gizem, Seker, Erdal, Ozisik, Mehmet Seckin
• Format: Journal Article
• Language: English
• Published: Galenos Yayinevi Tic. Ltd 01-03-2021
• Subjects: Abnormalities; Case studies; Diagnosis; Genital diseases, Female; Genitourinary organs; Pediatric research; Turkey
• ISSN: 2149-9322
• DOI: 10.4274/tjod.galenos.2020.44442

Persistent cloaca is a rare abnormality that occurs usually in females and is characterized by direct communication between the gastrointestinal, urinary, and genital structures resulting in a single perineal opening. We report a case of persistent cloaca accompanying uterus didelphys that was diagnosed antenatally with fetal ultrasonography. A gravida 3, para 2, 35-year-old women at 22 weeks of gestation was referred to our hospital with a diagnosis of moderate pyelectasis of the fetal kidneys and fetal diffuse intestinal dilation. Detailed ultrasound scan findings were reported as a small thick-walled septated cystic pelvic mass of 5.2*5.5 cm size seen at the level of the fetal pelvic region. The target sign could not be visualized, it was considered as anal atresia. In the following weeks, the patient, who was evaluated together with meconium on the uterine septum, and monitoring of the neighboring bladder and anal atresia, was diagnosed as having persistent cloaca. Ultrasound findings showed that it could be persistent cloaca accompanying uterus didelphys. The fetus postnatally manifested persistent cloaca. On the first day after vaginal delivery, pelvic ultrasound in the neonatal intensive care unit showed bilateral 2nd-degree hydronephrosis, presacral enlarged bowel loops, uterus didelphis, vaginal septum, direct contact between urethra and vagina, proximal end in the rectum compatible with atresia. On the second day, colostomy was performed. Her renal condition continued to be stable. She is now waiting for definitive surgery for cloaca. Persistent cloaca should be considered in any female fetus presenting with hydronephrosis and a cystic pelvic mass lesion as diagnosed by ultrasound. Prenatal diagnosis allows time for parental counseling and delivery planning at a tertiary hospital for neonatal intensive care and pediatric surgery. Keywords: Persistent cloaca, uterus didelphys, prenatal diagnosis, fetal pelvic mass Persistan kloaka, genellikle kadinlarda gorulen; gastrointestinal, uriner ve genital yapilar arasinda dogrudan tek bir perineal agiklikla karakterize nadir gorulen bir anomalidir. Fetal ultrasonografi ile antenatal olarak tani konulan uterin didelfisin eslik ettigi bir persistan kloaka olgusunu sunuyoruz. Otuz bes yasinda kadin, gravida 3, para 2, fetal bobreklerde orta derecede piyelektazi ve fetal diffuz intestinal dilatasyonu olan 22 hafta gebelik tanisiyla hastanemize sevk edildi. Detayli ultrason taramasi bulgulari, fetal pelvik bolge seviyesinde 5,2*5,5 cm boyutlarinda kucuk kalin duvarh septasyonlu kistik pelvik kitle olarak rapor edildi. "Target sign" goruntulenemedi, anal atrezi olarak degerlendirildi. ilerleyen haftalarda uterin septumda mekonyum gorulmesi, komsulugunda mesanenin izlenmesi ve anal atrezisi olan hastaya persistan kloaka tanisi konuldu. Ultrason bulgulari, uterin didelfisin de eslik ettigini gosterdi. Vajinal dogumdan sonrasi persistan kloaka gosterildi, yenidogan yogun bakim unitesinde yapilan pelvik ultrasonda bilateral 2. derece hidronefroz, presakral diffuz intestinal segmenti, uterus didelfis, vajinal septum, uretra ve vajina arasinda direkt temas, rektumda proksimal ug atrezisi raporlandi. ikinci gun kolostomi acildi. Renal durumu stabil devam eden hasta simdi kloaka icin cerrahisi bekliyor. Ultrason ile tani konulmus kistik pelvik kitle ve hidronefroz ile gelen her kiz fetuste persistan kloaka dusunulmelidir. Prenatal tani, yenidogan yogun bakim ve cocuk cerrahi olan uguncu basamak bir hastanede ebeveyn danismanligi ve dogum planlamasi icin zaman saglar. Anahtar Kelimeler: Persistan kloaka, uterus didelfis, prenatal tani, fetal pelvik kitle